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The respiratory distress that accompanies emphysema is caused by:

  1. acute fluid accumulation in the alveoli

  2. chronic stretching of the alveolar walls

  3. massive constriction of the bronchioles

  4. repeated exposure to cigarette smoke

The correct answer is: chronic stretching of the alveolar walls

The respiratory distress that accompanies emphysema is caused by chronic stretching of the alveolar walls. This is due to damage to the walls of the alveoli, resulting in a decrease in their elasticity. Option A is incorrect because acute fluid accumulation in the alveoli is characteristic of pneumonia and not emphysema. Option C is incorrect because although bronchoconstriction can occur in emphysema, it is not considered a major cause of respiratory distress. Option D is incorrect because while cigarette smoke can contribute to the development of emphysema, it is not the direct cause of respiratory distress in this condition.